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28 August 2012

Midwest Edition
Calendar
September 6-8
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Health Care REIT Acquires Sunrise


$2 Billion Deal Takes Midwest Company Upscale
A May 2012 study in the journal Health Services Research found a 10% increase in assisted living capacity between 1993 and 2007. At the same time there was a 1.4% decline in private pay occupancy in nursing homes. It may be small, but it does show a shift in movement toward assisted living. The crown jewels of that market are higher-end private pay communities. And the Ohio-based Health Care REIT, Inc. just purchased an extremely large chunk of that market in a $1.9 billion deal to acquire Sunrise Senior Living, Inc. REIT acquired 20 of Sunrises whollyowned senior housing communities as well as interest in the McLean, Va.-based companys joint ventures. Sunrise employs almost 32,000 people and operates just more than 300 communities at of June 2012, according to company data. This acquisition powerfully advances our strategic vision: own the highest quality, private-pay seniors housing communities in strong, growing, afuent markets and align with experienced, dynamic management teams, said George L. Chapman, Health Care REIT's chief executive ofcer. This transaction positions us to build on our collaborative, relationship based investment philosophy and benet from the ongoing transformation of the sector. There are few opportunities to acquire assets of this quality in a transaction of this scale. Although many such residents of these communities live with little or no assistance, most have sizable skilled nursing facilities attached. Residents often segue into those communities as they age and become more frail. This is one of the bigger transactions in this market in recent years, said George Yedinak, founder and publisher of the trade pubication Senior Housing News. Based upon the history of Sunrise and its longstanding status in the assisted living world, it may be the dening transaction for 2012 thus far. This gives them some high-quality assets in major metro markets that have really great demographics and, most importantly, people that can pay privately, Yedinak said. Location, revenue per resident in the
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September 9-11
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October 3-5
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NEWS
REIT (Continued from Page One)
communities, the scope and sheer number of properties gives it some real panache. Then add the Sunrise brand to it and think there is a lot of potential. Yedinak said the industry seems to be splitting into communities whose residents are with money or without. Real estate owners are beginning to place a huge premium on communities where individuals can pay for their own care and housing. This acquisition powerfully advances our strategic vision: Own the highest quality, private pay seniors housing communities in strong, growing, afuent markets and align with experienced, dynamic management teams, said George Chapman, Health Care REIT's chairman and CEO in a press release. Sunrise has been a leader in the transformation of seniors housing. This transaction positions us to build on our collaborative, relationship based investment philosophy and benet from the ongoing transformation of the sector. There are few opportunities to acquire assets of this quality in a transaction of this scale. Yedinak said Sunrise was ripe for purchasing because of its choices during the real estate bubble. The organization took on a lot of debt and leverage to build some of its newer communities. They ran into nancial problems when credit markets went

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In Brief
Case Western Links Insomnia To More Aggressive Breast Cancers
Researchers at Case Western University and its affiliated hospital in Cleveland have linked lack of sleep to more aggressive tumors in breast cancer victims. The research team examined more than 400 post-menopausal breast cancer victims and queried about their sleep habits. Those women who had reported less than six hours of sleep a night on average were more likely to have tumors with a genetic makeup more likely to make them recur. This is the first study to suggest that women who routinely sleep fewer hours may develop more aggressive breast cancers compared with women who sleep longer hours, said Cheryl Thompson, a Case Western Reserve University School of Medicine and they studys lead author. We found a strong correlation between fewer hours of sleep per night and worse recurrence scoresthis suggests that lack of sufficient sleep may cause more aggressive tumors, but more research will need to be done to verify this finding and understand the causes of this association. The findings of the study were published in the most recent issue of the journal Breast Cancer Research and Treatment.

downhill. The company, he said, has been in restructuring mode for a few years, selling off assets and repositioning itself. This transaction is part of the ultimate restructuring, he said. One of the benets of the transaction for REIT is its interest in Sunrises ventures. According to a statement issued by REIT, the organization expects to own an average of 28% interest in 105 of Sunrises joint venture communities when the acquisition is complete. Thirty-seven will have purchase options in 2013, 13 have them in 2014. They have a pipeline where they can plan debt and equity offerings as well as property acquisitions, Yedinak said. They have a roadmap laid out for the next couple of years based on knowing when the options come into play. According to the companys statement, the acquisition makes REIT one of the largest owners of seniors housing in the world with more than 58,000 units in the United States, Canada and the United Kingdom. Sunrise is expected to operate the communities, but the terms are not being disclosed because of condentiality agreements and continued negations. The deal is expected to be completed in the rst half of 2013. TAMMY WORTH

Firms More Bullish On Coverage


Towers Watson Survey Says More Will Keep Plans
A new survey by the benets consulting rm Towers Watson reveals signicantly more companies are likely to retain employer healthcare benets after the primary components of the Affordable Care Act are deployed in 2014. According to the survey of 440 midsize and large employers (500+ workers), 88% say they intend to offer health insurance to their workers for the foreseeable future. That compares to just 71% in last years survey. The New York-based Towers Watson noted that the renewed commitment to employer-based healthcare benets comes even though costs are expected to increase 5.3% per employee in 2013, reaching an average of $11,507. Another 77% of rms say they consider healthcare benets as core to their employee value proposition over the next several years. However, more than a third of those companies also say they will examine their healthcare benets within a total rewards framework by 2013. Another 39% say they plan to do so during 2014 or 2015. Affordable healthcare remains a top priority for employers and a key component in employee value propositions, said Randall Abbott, senior healthcare consulting leader at Towers Watson. However, due to the increasing costs of medical benets and the additional burden of compliance, business leaders need to keep the pressure on to control costs, increase workforce accountability and engage workers to lead a healthier lifestyle. Towers Watson said it will release the full results of its survey next month, according to spokesperson Binoli Savani.

Minn. Blues, Innovalon Renew Pact


Blue Cross Blue Shield of Minnesota has renewed its contract

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Ohio Awards SPD HMO Contracts


Molina, Aetna Considered Big Winners in Bidding
The State of Ohio has awarded contracts to ve insurers to provider care to 114,000 Medicare-Medicaid seniors and persons with disabilities under a pilot program that begins in 2013. Connecticut-based Aetna, Inc. and California-based Molina Healthcare will be the lead health plans, with both winning contracts from the Ohio Department of Job and Family Services to provide care in the states densely populated central region. UnitedHealthcare of Ohio, Dayton-based CareSource, in conjunction with Humana Inc., and Buckeye Community Health Plan were the other contract winners. All the plans will serve three geographical regions apiece. People who are dually eligible for Medicaid and Medicare are among the most vulnerable populations, with multiple chronic conditions and complex health care needs, said CareSource Chief Executive Ofcer Pamela Morris. Today, they face the daunting challenge of navigating two separate programs often resulting in uncoordinated and costly care. The CareSource-Humana team will serve the northeast, east-central and northeast central regions, which include Akron, Cleveland and Youngstown and have 56,000 eligible lives. Centene and UnitedHealth will also be enrolling lives in the Cleveland area. Our experience coordinating care for atrisk individuals who are eligible for both Medicaid and Medicare in Ohio and across the country will allow us to improve health outcomes while helping reduce costs for the state of Ohio, said Amy Schultz Clubbs, president of Molina Healthcare of Ohio. Molinas contract includes the Dayton, Cincinnati and Columbus regions. Molinas recent earnings report noted its deep losses providing care for similar populations in Texas. A Molina spokesperson declined to comment on that issue. Aside from Aetna, all the plans currently provide managed care to Ohios general Medicaid population.

In Brief
with Inovalon to improve patient outcomes. The Eagan-based health plan and Bowie, Md.-based Inovalon, which was formerly known as MedAssurant, reached terms on what Inovalon called a multi-year engagement. As part of the deal, Inovalon will provide the Minnesota Blues with data-driven solutions to improve the overall healthcare outcomes for its commercial and Medicare Advantage enrollees. We are highly dedicated to delivering high quality, costeffective care to our members, said Frank Fernandez, vice president of government programs for the Minnesota Blues. We look forward to continuing our work with Inovalon to implement innovative programs and comprehensive services that help achieve these goals. Inovalon has been providing services to the Minnesota Blues since 2004.

Anthem Ohio In CPC Initiative


Working With 500 Provider Groups In Cincinnati
Anthem Blue Cross Blue Shield of Ohio will begin working with 75 physician practices in the Cincinnati and Dayton regions as part of a Medicare pilot project. The Ohio Blues and the practices were selected by the Centers for Medicare and Medicaid Services to participate in the Comprehensive Primary Care Initiative. The objective is to improve the primary care Medicare Advantage enrollees receive in order to cut down on more expensive hospitalizations. The Centers for Medicare and Medicaid Services chose 500 primary care medical groups in seven regions to participate in the pilot. Under the program, the providers will be paid an additional fee from CMS averaging about $20 per member per month to improve and better coordinate primary care services. Altogether, CMS has selected more than 2,100 providers who serve 313,000 Medicare enrollees in eight states. The Cincinnati/ Dayton/Kentucky region is the only Midwest area selected.

IHS Self-Study Focuses On Wellness Program


A study by Chicago-based firm Interactive Health Solutions found a correlation between the use of a wellness program and reduced healthcare costs. However, there is a catch: The study focused exclusively on IHS wellness clients, which were compared against a control group that did not use a wellness program. Another firm, Zoe Consulting, performed the study, using two years of medical claims data. According to the data, those enrolled in IHS wellness program included an average 6.1% reduction in medical cost trends and a 13.5% reduction among those enrollees with chronic conditions. Overall, 85% of those participating in wellness programs maintained their health without any deterioration.

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Payers & Providers

OPINION

Page 4

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Avoiding Physician Burnout Is Critical


Primary Care Access Will Be Under Threat Otherwise
A colleague of mine in primary care medicine than other workers. The issue of physician has decided to leave the practice of medicine. burnout is important. She is very well trained, has impeccable As the U.S. population grows and ages, professional credentials, and works in a the number of physicians needed to care for thriving practice. them increases. When burnout leads Over the past several years, however, she physicians to reduce or cease their practice has noticed an unrelenting decline in the altogether, patient access to medical care is sense of fulllment she derives from her work. diminished. Moreover, burned-out physicians She feels increasingly frustrated with what she are likely to be less productive, make more calls the "bureaucratization" of medicine, and mistakes, and generally deliver a lower quality resents spending "more time lling out forms of care than their fully engaged colleagues. than caring for patients." My colleague is Finally, physicians are human beings too, and suffering from what is commonly described as their suffering should summon no less burnout. compassion and concern than anyone else's. A new report in the Archives of Internal To enhance fulllment and quality of Medicine indicates that rates of burnout work, it is necessary to focus on the work among U.S. physicians signicantly itself. In the case of medicine, do By exceed those of the general physicians recognize what they nd population. This is a very serious issue Richard most fullling? If they cannot see the with effects that will ripple throughout target they are aiming for in this Gunderman,case, the aspects of their work that society, and it warrants widespread, M.D. earnest attention. The solution, though, they nd most meaningful and take does not lie in incentivizing physicians with most pride in they are unlikely to hit it. What money or restructuring systems to minimize does their best work look like? Are they stress on physicians it lies in nding earnest making full use of their knowledge, skills, and professional fulllment. innate abilities? Are they growing and Medicine is not a job. It is not even a developing as human beings? Do they feel career. At its heart, medicine is a calling. that they are making a real difference in the According to psychologists, signs of burnout lives of their patients and communities? include decreased enthusiasm for work, Burnout is not a disease. It is a symptom. growing cynicism, and a low sense of personal The key to combating physician burnout is not accomplishment. As the name implies, to reduce stress, but to promote professional individuals suffering from burnout feel as fulllment. And promoting professional though a re that once burned inside them has fulllment is not merely a matter of reducing dwindled, and perhaps even been entirely costs and error rates or increasing clinical extinguished. efciency. Of nearly 7,300 physicians who If we are genuinely concerned about participated in the Archives of Internal physician burnout, we need to focus less on Medicine's national survey, 46% reported at reducing stress and more on promoting what least one symptom of burnout, and the overall is best in physicians: compassion, courage, rate of burnout among physicians was 38%, as and above all, wisdom. Only by keeping what opposed to 28% among other U.S. workers. matters most at the forefront can we reap a full The highest rates of burnout were reported harvest of professional fulllment. among primary care physicians, including family physicians and general internists. Why should rates of burnout be higher Richard Gunderman, MD, is a faculty member among physicians? For one thing, physicians at Indiana University and a regular contributor tend to work longer hours than other workers, to The Atlantic online, where this blog was on average about 10 more hours per week. originally published in its entirety. Moreover, striking an appropriate work-life balance appears to be a bigger challenge for physicians, in part because they often tend to Op-ed submissions of up to 600 words are keep work and personal life more separated welcomed. Please e-mail proposals to
editor@payersandproviders.com

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